In this lesson we're going to continue talking about how nutrition modeling in LIST is done. And here we're particularly going to focus on nutrition in LIST. We've seen this image before and what it is is a filter on stunting in the LIST visualizer. Again, the LIST visualizer we'll see it in many other lectures, but what it is is the insides of LIST and it shows how things are interrelated in LIST. So we're first going to look at stunting as a risk factor. So we're looking at the right hand side of this particular image. So we're looking at the arrows that are coming from stunting and that go onwards towards pneumonia, diarrhea, meningitis, measles, et cetera. So the relative risk of a cause specific mortality due to stunting will increase by the level of stunting severity. That's a pretty straightforward thing to understand, hopefully. The more stunted you are, or the more stunted the child is, the higher the likelihood that they will die from this from this particular illness. In this particular part of the model, stunting asks directly to cause specific deaths. So the effectiveness leads to a direct impact of under nutrition on mortality. So this screenshot that you see at the bottom of the screen is just looking at the diarrhea as an example. But this would be true for any of the other cause specific mortalities that we've just talked about. Namely pneumonia, diarrhea, which is the example here, all of these other causes of deaths that were on the right hand side of the image. To interpret the graph a little more, you see going across the top, we have our age categories. So the relative risk is the same in this particular case for diarrhea from 1 to 59 months. But we do have these age brackets because depending on the interventions, they might actually change. In this case they don't. So we have our age brackets from 1 to 5 months, 6 to 11 months, 12 to 23 months, and then 24 to 59 months to five years old. And then going down in the rows you see that if the child is less than one standard deviation than the median norm, so that actually means if the child is not stunted, the relative risk is one. Meaning there's no additional risk to the child for healthy body weight. Between one and two, the rate increases, the relative risk increases rather, and that child is still technically not stunted because the cut off is two standard deviations. But already we're seeing a little bit of an increased relative risk. If the child is moderately stunted, so between two and three standard deviations, then we do have a significant increase. We're looking at more than twice the relative risk than a child that is not stunted. And finally, if the child is three or more, then we get this great big jump in terms of relative risk for mortality. So, again, this exact information exists for all of these, the other outcomes of child mortality directly related to stunting. And this holds true for all of them. The more severely stunted you are, the more likely you are to die from one of the cause specific mortality. So now that we've looked at the right hand side, so we looked at the link between stunting and diarrhea, pneumonia, meningitis, measles and other causes death. We're now going to talk about the left hand side. So how do we affect stunting? What are the interventions that actually impacts stunting so that they can in turn, affect the ultimate mortality outcomes? So for the first half of the image we've already shown, we're looking at how these different interventions impact stunting. So the effectiveness of the interventions will have an impact on stunting. So if we start with the first one, we're looking at the impact of the birth outcomes on stunting. We start with the appropriate for gestational age and term. So that means the child was not preterm and was not small for its gestational age. So basically it's a normal baby, so to speak. And that has relative risk of one but basically no increased relative risk. And then moving down the chain, if the child did come to term but was small for gestational age, we have a slight increase in the relative risk for stunting. And then if the child was preterm but appropriate for gestational age. So it came early but it was the appropriate size for its gestational age, then the relative risk increases also, but more than if it was term and small for gestational age. And finally if it came both early, so it was preterm and it was small for its gestational age, then we have a very very high risk for having a child that has stunting. LIST also models the impact of previous stunting on stunting. So children aged from these age cohorts. So we've looked at how it separates children out into all these different age categories. So if a child was stunted in its previous categories, so if it was stunted between 1-5 months, then it is likely to be stunted also from 6 to 12 months. So that's what we mean by the impact of previous stunting on stunting. The impact of complementary feeding on stunting. So if the child is food secure and receives the promotion, then they're essentially is no relative risk. That is a child that gets enough to eat and that their parents get information on what they should be feeding that child, so that is a relative risk of one. Then if the child is food secure but doesn't receive promotions, so their parents don't get the counseling, there is a slight increase in the relative risk. And then going down the chain, if the child is food insecure but does receive both promotion and supplementation. So actually he receives a food supplement as well as how to use or what they should be eating or rather their parents receive this, then there's still an increased relative risk. And finally, the children most at risk for stunting is, as you can imagine, children who are both food insecure and don't receive either promotion or supplementation in terms of complementary feeding. And those are the children most at risk for being stunted. The impact of diarrhea, we're going to talk about a little bit later in this same module how diarrhea gets modelled or diarrhea incidents gets modeled in the software. But for the purposes of this lesson, the takeaway is just that diarrhea incidents has an impact on stunting. And finally zinc supplementation also has an impact on stunting. That is a straightforward number that LIST uses to calculate the impact on stunting. So that sums up the different mechanisms for how LIST looks at stunting. If you have more questions or you want to learn a little bit more, broad recommendation would be to refer to the LIST visualizer and just click around and find out more of where these information are coming from and the assumptions that the LIST software makes.